People treated for
Hodgkin lymphoma
with radiation therapy have
a substantially higher risk of stroke,
according to a new study published
in the Journal of the National Cancer
Institute.

The study was undertaken because
information on clinically verified
stroke and transient ischemic attack
(TIA), or a “mini stroke,” following
Hodgkin lymphoma is limited.

In order to quantify the long-term
risks, Flora E. van Leeuwen, PhD, of
the Department of Epidemiology at
the Netherlands Cancer Institute in
Amsterdam and colleagues performed
a retrospective cohort study among
2,201 Hodgkin lymphoma survivors.
The researchers compared incidence
rates of clinically verified stroke and
TIA in this cohort with rates in the
general population.

After a median follow-up of almost
18 years, 96 people developed cerebrovascular
disease. The incidence rate
for stroke was 2.2 times the incidence
in the general population. For TIA, it
was 3.1. Risks also remained elevated,
compared to those in the general population,
after prolonged follow-up.
Radiation to the neck and mediastinum
was associated with increased risk,
whereas chemotherapy was not.

“For young survivors of Hodgkin
lymphoma, who are at especially
increased risk of stroke and TIA,
physicians should consider appropriate
risk-reducing strategies, such as
treatment of hypertension and lifestyle
changes to reduce the risk of stroke
and TIA,” the authors write.

In an accompanying editorial, Dan L.
Longo, MD, of the National Institute on
Aging, part of the National Institutes of
Health in Bethesda, MD, discusses the
study’s contribution to the “already
overwhelming evidence that radiation
therapy in Hodgkin’s disease is shortsighted
….” He applauds the detailed
medical documentation and nearly
complete follow-up of the participants
in the study, but notes a weakness in
that the relationship of stroke to radiation
doses was not examined.

According to Dr. Longo, results of
this study should affect a physician’s
choice of primary treatment. “Unfortunately,
given the life-long increased
risks of late effects that have been documented
from the use of radiation
therapy, we simply cannot keep exposing
patients to risk without clear benefit
while we wait for safety data to be produced,”
he writes. “With an alternative
therapy at hand that is just as effective
…, it is simply unjustified to keep using
a toxic modality for the next 10
to 20 years ….”

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This article was originally published in Coping® with Cancer magazine,
September/October
2009.